- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $63.50 / $1,561.59 / $19,211.14
| Facility | | $63.50 | $1,561.59 | $19,211.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,888.00 / $9,888.00 / $25,437.00
| Facility | | $2,888.00 | $9,888.00 | $25,437.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $78.17 / $109.49 / $1,630.31
| Facility | | $78.17 | $109.49 | $1,630.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,370.92 / $3,370.92 / $3,370.92
| Facility | | $3,370.92 | $3,370.92 | $3,370.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,800.00 / $10,000.00 / $15,750.00
| Facility | | $3,800.00 | $10,000.00 | $15,750.00 |